Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement?
Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement?
复制标题
接受冠状动脉旁路移植术的老年患者胸内动脉移植：流程改进的空间？
DOI：
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发表时间：
2002
影响因子：
6
通讯作者：
E. Peterson
中科院分区：
文献类型：
--
作者：
T. Ferguson;L. Coombs;E. Peterson
客观化
在接受冠状动脉搭桥术的年轻患者中，胸腔内动脉移植的急性和长期益处是显而易见的。然而，老年人面临较高的手术风险和较短的预期寿命，因此在这个年龄段使用胸内动脉移植一直存在争议。这项研究调查了75岁及以上患者胸内动脉移植的用途、并发症风险和手术(30天)死亡率。
方法
1996至1999年间，胸外科医师协会国家心脏数据库中的522,656名患者接受了初次非紧急挽救冠状动脉搭桥术；其中99,942名患者年龄在75岁或以上。通过(1)风险调整(调整了28个基线危险因素和部位)和(2)治疗倾向评分分析，比较了具有相似基线可能性接受胸内动脉移植的患者，研究了胸内动脉使用对该老年组手术死亡率和5个主要并发症的影响。
结果
在国家心脏数据库中，77.4%的75岁至84岁的患者接受了胸腔内动脉移植，而55岁或55岁以下的患者这一比例为93.5%。在这一老年组中，使用胸腔内动脉与手术死亡率(未经调整的死亡率，6.20%比4.05%；P<；0.0001)密切相关，在控制了基线风险和提供者影响(调整后的优势比，0.85；95%可信区间，0.79-0.91)后仍持续存在。这一死亡率收益在接受胸内动脉移植的基线倾向从低到高的患者中可见。
结论
在接受冠状动脉搭桥术的老年患者中使用胸廓内动脉可提供急性生存益处。这种益处与在年轻患者中看到的相似，并在根据患者和提供者选择因素进行调整后持续存在。在接受搭桥手术的老年患者中，胸廓内动脉似乎没有得到充分利用，这是一个潜在的质量改进区域。
OBJECTIVE
The acute and long-term benefits of internal thoracic artery grafting are clear in younger patients undergoing coronary artery bypass grafting. The elderly, however, face higher surgical risks and have shorter life expectancy, and thus the use of internal thoracic artery grafting in this age group has been debated. This study examined the use, complication risks, and operative (30-day) mortality associated with internal thoracic artery grafting in patients 75 years of age and older.
METHODS
Between 1996 and 1999, 522,656 patients in the Society of Thoracic Surgeons National Cardiac Database underwent primary, nonemergency-salvage coronary artery bypass grafting; of these, 99,942 were 75 years of age or older. The influence of internal thoracic artery use on operative mortality and 5 major complications in this elderly group was examined by means of (1) risk adjustment (adjusting for 28 baseline risk factors and site) and (2) a treatment propensity score analysis that compares patients with similar baseline likelihood for receiving an internal thoracic artery graft.
RESULTS
In the National Cardiac Database 77.4% of patients aged 75 to 84 years received an internal thoracic artery graft compared with 93.5% for those aged 55 years or less. In this elderly group use of the internal thoracic artery was strongly associated with decreased operative mortality (unadjusted mortality, 6.20% vs. 4.05%; P <.0001) that persisted after controlling for baseline risk and provider effects (adjusted odds ratio, 0.85; 95% confidence intervals, 0.79-0.91). This mortality benefit was seen among those with low-to-high baseline propensity for receiving an internal thoracic artery graft.
CONCLUSIONS
Use of the internal thoracic artery in elderly patients undergoing coronary artery bypass grafting provides an acute survival benefit. This benefit is similar to that seen in younger patients and persists after adjusting for both patient and provider selection factors. The internal thoracic artery appears to be underused in elderly patients undergoing bypass grafting and is a potential area for quality improvement.
影响因子：
120.7
作者：
OConnor, GT;Plume, SK;Kasper, JF
通讯作者：
Kasper, JF